Yousef Yacoub A, Finger Paul T
The New York Eye Cancer Center, New York, NY 10065, USA.
Arch Ophthalmol. 2012 May;130(5):599-606. doi: 10.1001/archophthalmol.2011.2566.
To evaluate the predictive value of the seventh edition American Joint Committee on Cancer (AJCC) staging system for conjunctival melanoma.
Retrospective, observational case series of 42 eyes of 42 patients with conjunctival melanoma studied by reviewing medical records, pathology reports, and color photographs. The main evaluated outcomes were demographic information, laterality, tumor size, thickness, pathologic diagnosis, seventh edition AJCC stage (clinical and pathologic), recurrence, metastasis, and duration of follow-up.
There was no sex preference, and the median age was 61 years. Recurrent disease was noted in 33% of patients (n = 14 of 42), with 64% occurring at a median of 2.5 years (range, 1-5 years) after primary treatment. Metastasis was noted in 19% of patients. The significant predictive factors for high risk of tumor recurrence were tumors involving more than 1 quadrant (P = .02), tumors thicker than 0.5 mm (P = .04), and tumor multifocality (P = .04). The significant predictive factors for high risk of tumor metastasis were tumors thicker than 0.5 mm (P = .005), tumor invasiveness (P = .04), pathologic diagnosis of conjunctival melanoma rather than melanoma in situ (P = .04), and tumor recurrence (P < .001). Similarly, increasing AJCC T stages (clinical and pathologic) were associated with unfavorable outcomes. For example, clinical stage-related recurrence rates were 19% (Tis), 27% (T1), 33% (T2), and 75% (T3). Clinical stage-related lymphatic and distant metastasis rates were 0% (Tis), 20% (T1), 0% (T2), and 63% (T3).
Advanced AJCC T-stage (clinical and pathologic) tumors were at higher risk for recurrence and metastasis. In this study, the seventh edition AJCC staging system was predictive of local control and systemic spread of conjunctival melanoma.
评估美国癌症联合委员会（AJCC）第七版分期系统对结膜黑色素瘤的预测价值。
通过回顾病历、病理报告和彩色照片，对42例结膜黑色素瘤患者的42只眼进行回顾性观察病例系列研究。主要评估结果包括人口统计学信息、患侧、肿瘤大小、厚度、病理诊断、AJCC第七版分期（临床和病理）、复发、转移及随访时间。
无性别偏好，中位年龄为61岁。33%的患者（42例中的14例）出现疾病复发，其中64%发生在初次治疗后的中位时间2.5年（范围1 - 5年）。19%的患者出现转移。肿瘤复发高风险的显著预测因素为累及超过1个象限的肿瘤（P = 0.02）、厚度超过0.5 mm的肿瘤（P = 0.04）和肿瘤多灶性（P = 0.04）。肿瘤转移高风险的显著预测因素为厚度超过0.5 mm的肿瘤（P = 0.005）、肿瘤浸润性（P = 0.04）、结膜黑色素瘤而非原位黑色素瘤的病理诊断（P = 0.04）以及肿瘤复发（P < 0.001）。同样，AJCC T分期（临床和病理）增加与不良预后相关。例如，临床分期相关的复发率分别为19%（Tis）、27%（T1）、33%（T2）和75%（T3）。临床分期相关的淋巴和远处转移率分别为0%（Tis）、20%（T1）、0%（T2）和63%（T3）。
AJCC T分期（临床和病理）较晚的肿瘤复发和转移风险更高。在本研究中，AJCC第七版分期系统可预测结膜黑色素瘤的局部控制和全身扩散情况。
